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[Use of the evidence-based guidelines for management of bronchiolitis]
Ana Lorena Oñate Ramírez1, Mario Enrique Rendón Macías2, José Iglesias Leboreiro3
1División de Posgrado, Facultad Mexicana de Medicina, Universidad La Salle, México, D.F., México.
Insights
Despite the availability of evidence-based guidelines for acute bronchiolitis, medical care practices for children under five years old show incomplete adoption. This highlights a gap between recommended and actual clinical management, impacting pediatric respiratory care.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Evidence-Based Medicine
Context:
- Acute bronchiolitis is a common respiratory infection in infants and young children.
- Clinical practice guidelines aim to standardize and improve the management of acute bronchiolitis.
- Variations in adherence to guidelines can affect patient outcomes and healthcare resource utilization.
Purpose:
- To evaluate the adherence of medical care for hospitalized children under five with acute bronchiolitis to established evidence-based guidelines.
- To compare clinical practices against recommendations from major pediatric and respiratory care organizations.
- To identify potential barriers or factors influencing guideline adoption in pediatric practice.
Summary:
- A retrospective chart review of 197 hospitalized infants with acute bronchiolitis was conducted.
- Analysis revealed inconsistent application of guideline-recommended interventions such as secretion aspiration, supplemental oxygen, and hypertonic saline.
- Non-recommended treatments, including inhaled bronchodilators, steroids, antibiotics, and systemic steroids, were frequently administered, particularly by less experienced physicians.
Impact:
- Findings indicate a significant gap between evidence-based recommendations and actual clinical practice in managing acute bronchiolitis.
- The study underscores the need for improved dissemination and implementation strategies for clinical guidelines in pediatric settings.
- Addressing the suboptimal adoption of guidelines can lead to more effective and evidence-based care for children with acute bronchiolitis.
Introduction:
The aim of this study was to analyze the medical care of children<5 years of age with acute bronchiolitis in relation to the most relevant practices of evidence-based guidelines for bronchiolitis.
Methods:
We reviewed the charts of 197 hospitalized infants with acute bronchiolitis during 2012 to 2013 to analyse whether the guideline recommendations were used according to: American Academic of Pediatritians (AAP), Scotish Intercollegiate Guidelines Network (SIGN), Sector Salud México (SS), and Guía Práctica Clínica Bronquiolitis, España (GPCBA).
Results:
We evaluated 197 patients attended by 49 pediatricians. Of the recommended actions, in 110 patients (55.8%) aspirate secretions were indicated, 105 patients (53%) received supplemental oxygen and 63 patients (31.9%) used inhaled hypertonic solution. Non-recommended actions were carried out in 166 patients (84%) who received inhaled bronchodilators, 143 patients (72%) who inhaled steroids, 110 patients (55.8%) who were prescribed antibiotics, 76 patients (38%) who had nebulization and 52 patients (26.3%) were administered systemic steroids. Physicians with<10 years of expertise prescribed more systemic steroids.
Conclusions:
Despite the dissemination of good clinical practice guidelines for the management of acute bronchiolitis, its adoption has not been totally completed.
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